Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members

Objective: Endometriosis constitutes a significant burden on the quality of life of women, their families and healthcare systems. The objective of this study is to describe the real-world epidemiology of endometriosis in an unselected low-risk population in Israel. Design: Retrospective population-based study. Setting and sample: The computerised databases of Maccabi Healthcare Services (MHS), a 2-million-member healthcare provider representing a quarter of the Israeli population. Methods: The crude point prevalence (31 December 2015; diagnosed since 1998) and annual incidence (2000–2015) rates of diagnosed endometriosis (ICD-9-CM 617.xx) were assessed among women aged 15–55 years. Prevalent patients were characterised in terms of sociodemographic and clinical characteristics, including validated MHS infertility and chronic disease registries. Main outcome measures: Prevalence and incidence of diagnosed endometriosis in MHS. Results: The point prevalence of endometriosis [n = 6146, mean age 40.4 ± 8.0 years (SD)] was 10.8 per 1000 (95% CI 10.5–11.0). Women aged 40–44 years had the highest prevalence rate of 18.6 per 1000 (95% CI 17.7–19.5). Infertility was documented in 37% of patients. A total of 6045 patients were included in the cohort of newly-diagnosed endometriosis (mean age 34.0 ± 8.1 years), corresponding to an average annual incidence rate of 7.2 per 10 000 (95% CI 6.5–8.0). Conclusions: We observed a substantially lower prevalence of diagnosed endometriosis compared with previous reports in high-risk populations, in line with population-based estimates from European databases (range 0.8–1.8%). Further characterisation of this cohort may help to understand what affects the prevalence of endometriosis in Israel, and to promote earlier diagnosis and improve management in clinical practice. Tweetable abstract: Endometriosis diagnosed in 1% of women, according to a large population-based study in a community setting.